Healthcare Provider Details

I. General information

NPI: 1023431749
Provider Name (Legal Business Name): KELSEY O'CONNOR CAMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E EMMA AVE
SPRINGDALE AR
72764-4634
US

IV. Provider business mailing address

610 E EMMA AVE
SPRINGDALE AR
72764-4634
US

V. Phone/Fax

Practice location:
  • Phone: 479-751-7417
  • Fax: 479-751-4898
Mailing address:
  • Phone: 479-751-7417
  • Fax: 479-751-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR082960
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004019
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: